急性解離に対する上行置換後に末梢吻合部リエントリーに対してステントグラフト内挿術を行った1例

Thoracic Endovascular Aortic Repair for Re-entry of Distal Anastomosis Following Ascending Replacement for Acute Aortic Dissection：Report of a Case

はじめに　Stanford A型急性大動脈解離（Stanford type A acute aortic dissection：TAAAD）に対して上行大動脈置換術（ascending aortic replacement：AAR）を行った後に，末梢側吻合部（distal anastomosis：DA）に生じた新たなエントリー（new entry：NE）によると考えられる遠位弓部大動脈の偽腔（false lumen：FL）拡大により，解離性大動脈瘤（dissecting aortic aneurysm：DAA）を形成した症例を経験した．本例のDAに，NE閉鎖を目的として胸部大動脈ステントグラフト（stent graft：SG）内挿術（thoracic endovascular aortic repair：TEVAR）を行ったので，文献的考察を加え報告する．

A 61-year-old female underwent ascending aortic replacement （resecting the primary entry in the ascending aorta） for Stanford type A acute aortic dissection 1 year and 8 months before. Her postoperative course was uneventful, and the patient was discharged on 17 days later. Follow-up recent computed tomography （CT） scans, however, revealed dissecting aortic aneurysm of the distal aortic arch due to a new entry at the distal anastomosis of the ascending replacement. Thoracic endovascular aortic repair （placing a short stent graft, 52-mm Valiant Navion, into the ascending aorta） was successfully performed to occlude the new entry. Post-procedural CT scans indicated retrograde flow into the false lumen of the aortic arch via a re-entry of the left subclavian artery, and endovascular repair to exclude the re-entry is now planned.